Leukapheresis reduces 4-week mortality in acute myeloid leukemia patients with hyperleukocytosis - a retrospective study from a tertiary center

• Published in: Leukemia & lymphoma Vol. 58; no. 9; pp. 2110 - 2117
• Main Authors: Nan, Xinyu, Qin, Qian, Gentille, Cesar, Ensor, Joe, Leveque, Christopher, Pingali, Sai R., Phan, Alexandria T., Rice, Lawrence, Iyer, Swaminathan
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 02.09.2017
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bone Marrow - pathology; Case-Control Studies; Female; Humans; hyperleukocytosis; Leukapheresis; Leukapheresis - methods; leukemia; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - pathology; Leukemia, Myeloid, Acute - therapy; Leukocyte Count; Male; Middle Aged; Registries; Retrospective Studies; leukemia; Leukapheresis; hyperleukocytosis
• ISSN: 1042-8194; 1029-2403
• DOI: 10.1080/10428194.2016.1277386

Hyperleukocytosis in patients with acute myeloid leukemia (AML) can lead to leukostasis, which if left untreated, has a high mortality. While prompt cytoreductive chemotherapy is essential, treatment with leukapheresis is controversial. This study investigated the outcomes of patients with hyperleukocytosis who received leukapheresis. From 5596 encounters of patients with leukemia seen at Houston Methodist Hospital, we identified 26 patients who had newly diagnosed AML, WBC >50,000/μL, and received leukapheresis. We matched 26 patients who had similar baseline characteristics but did not receive leukapheresis. The primary endpoint was to compare the 28-day mortality rates between the treatment and the control groups. Secondary endpoints were 6-month, 1-year, and 2-year mortality rates. Using multivariate logistic regression analysis, leukapheresis was associated with significantly lower 28-day mortality rate (30.8% vs. 57.7%, p = .022). There was, however, no difference in long-term mortality rate. Our study demonstrates the short-term mortality benefit of using leukapheresis in AML patients presenting with hyperleukocytosis.